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Frequently Asked Questions

Can the coordinator help me understand my medications?

--YES

Does the coordinator visit me in my home?

--YES

Will the coordinator help me get home safety devices?

--YES

Do you provide transportation, housekeeping, and bathing?

--YES

Are your caregivers trained, bonded and insured?

--YES

What is Northland Care Coordination for Seniors (NCCS)?

NCCS is a community based service program that helps seniors to live in their home healthier, safer, and more independently. This program provides Medicare and/or Medicaid eligible enrollees, their families, caregivers, and professional health care providers flexibility to meet health care needs and improve care and the quality of life.

Who is Eligible?

Predominantly people age 55 and older, enrolled in Medicare and/or Medicaid (can be Medicare only), and typically living with certain disabilities or health issues that require some degree of daily living assistance. This program is not insurance coverage where an enrollee may or may not use the benefits.  Also, anyone 21 years of age or older, enrolled in Medicaid.

What Services are Covered?

NCCS offers services typically covered by Medicaid but unavailable to those who are not qualified.  The service offering is a coordinated care service that allows a community-based interdisciplinary team (IDT) to direct the care for each participant.  The care coordination can be designed to accommodate the individual varying needs.  The costs for the NCC program are provided through a funding initiative sponsored by Centers for Medicare & Medicaid Services (CMS) and managed by Northland Healthcare Alliance, Northland PACE and other local providers.  In its current format the costs for the care coordination service is free.  As other healthcare services are needed, the participant's Medicare and Medicaid plans will be used to cover the costs of treatments. 

What are the Benefits?

Mandatory

  • Coordinated care management using a community based interdisciplinary team (IDT)

Optional (referrals made on an as needed basis)

  • Primary care (including your doctor and nursing services)
  • Home care
  • Physical therapy
  • Occupational therapy
  • Adult day care
  • Recreational therapy
  • Meals
  • Nutritional counseling
  • Social services
  • Social work counseling
  • Transportation to and from the adult day care center
  • Other Transportation
  • Other Services as needed
What about Medicaid and/or Medicare Services?

The participant must be enrolled in Medicaid and/or Medicare so they can continue to receive services on a fee-for-service basis through private Medicare sponsors or through their Prescription Drug Plan and Medicare Supplement plans.

What about Nursing Home Services?

The Northland NCCS product sponsor would not be responsible for nursing home costs but would assist the participant to or from the nursing home as part of the coordinated care program.

What are the costs of the program?

Actually the program is a Centers for Medicare & Medicaid Services (CMS) Innovations Initiative that provides the service in partnership with Northland Healthcare Alliance and fees are paid through this partnership.  So, there is no fee for the care coordination and management associated with the program.  However, the participant will need to pledge to support the IDT recommendations and comply with the direction given to stay healthy and improve the care processes. 

What is the NCCS Participant Cost Sharing?

There are no additional costs charged except the existing deductibles, copayments, or coinsurance.

Where is the prescription drug benefit and how will drugs and medications be handled?

The current Primary care provider can continue to prescribe drugs to the participants. The participant will continue to either pay out-of-pocket drug costs or enroll in a Medicare Part D plan. They would then follow the provisions of the benefit purchased.  One of the many benefits of this program is the help that comes in managing those medications.

Why would you participate in this program with all the options in the market today?

Most people underestimate how important home is to seniors. The NCCS services allows the participants to work with a team that collaborates and recommends only what they need and gives peace of mind that someone is coordinating their overall health care and day to day living needs.

What are some of the services that are unique to this program?

There are several including the team approach to managing care through a care plan and also the use of an adult day center for participants as a valuable place to receive healthy benefits.

Why would you come to an adult day center instead of remaining home for services?

Participants do not have to go to a center. In many cases it depends on their distinct needs but it is a great option that provides snacks, meals, socialization and healthy interaction.

How is care coordinated with other payers and providers?

Northland is working with local providers and partners that can bring comprehensive Medicaid and/or Medicare medical and prescription drug services to NCCS participants.  The partners would have standard benefits available for NCCS participants to select from as Medicare and Medicaid providers or the NCCS participant may choose to address their needs on their own.  From a coordinated care effort perspective, it would be ideal if the NCCS participant selected a community partner to provide Medicaid and/or Medicare support services.

What if the IDT recommends a package of benefits that the prospective participant can’t afford?

The IDT is an interdisciplinary team (meaning different specialties, nursing, primary care physician, a pharmacist, a social worker, a dietician, etc.,) that takes a team  approach to review significant events that may require further attention and create or review care plans for participants to improve their health. The IDT would then want to determine if a reduced and less costly service package will preclude them from being able to coordinate the participant’s care. The objective is to coordinate care services and provide guidance and options. The care coordination may be the only service that a participant may use, and that is fine.

Can the Coordinator help me understand my medications?

Yes.

Does the Coordinator visit me in my home?

Yes

Will the Coordinator help me get home safety devices?

Yes

 

The project described was supported by Grant Number 1C1CM331042 from the Department of Health and Human Services, Center for Medicare and Medicaid Services.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.